摘要
目的 探讨人体成分测量指导的透析方案对维持性血液透析患者心血管预后的影响.方法 选取2021年8月至2021年12月于天津医科大学朱宪彝纪念医院血液净化中心行维持性血液透析的134例患者为研究对象,按照患者是否根据人体成分分析结果调整透析方案分为观察组(72例)和对照组(62例),收集其基线时临床资料,随访2年,观察两组患者发生全因死亡、心血管源性死亡及心血管事件的情况.结果 基线时两组患者年龄、透析龄、白蛋白、总蛋白、血红蛋白、尿素氮、血肌肝、估算的肾小球滤过率、甘油三酯、总胆固醇、铁蛋白、血氯、血磷、血清铁和CO2结合力差异有统计学意义(P均＜0.05).根据生物电阻抗检测结果制定透析方案是维持性血液透析患者发生全因死亡(OR=5.188,95％CI:1.148～23.457,P=0.032)、心血管源性死亡(OR=15.618,95％CI:1.858～131.299,P=0.011)和心血管事件(OR=19.772,95％CI:3.096～126.284,P=0.002)的独立保护因素,年龄是发生心血管源性死亡(OR=1.072,95％CI:1.001～1.148,P=0.047)和心血管事件(OR=1.111,95％CI:1.022～1.207,P=0.013)的独立危险因素.容量异常均是发生全因死亡(OR=7.979,95％CI:1.162～54.784,P=0.035)及心血管事件(OR=73.059,95％CI:1.955～2 730.652,P=0.020)的独立危险因素.结论 根据人体成分分析结果制定透析方案可以明显改善维持性血液透析患者心血管预后情况,对心血管事件、心血管源性死亡以及全因死亡具有独立保护作用,其中过多水负荷值是维持性血液透析患者发生全因死亡和心血管事件风险的预测因子.
Abstract
Objective To explore the effect of body composition analysis-guided dialysis prescrip-tion on cardiovascular prognosis in maintenance hemodialysis(MHD)patients.Methods All participants were selected among MHD patients admitted to Hemodialysis Center of the Tianjin Medical University Chu Hsien-I Memorial Hospital from August 2021 to December 2021.According to whether the patients adjusted their dialysis prescription according to the results of body composition detection,A total of 134 patients met the inclusion criteria and were divided into observation group(n=72)and control group(n=62).General profiles and laboratory parameters were recorded at baselines and followed up for 2 years.The all-cause death,cardiovascular death and cardiovascular events were observed in the two groups.Results At base-line,there were statistically significant differences in age,dialysis age,albumin,total protein,hemoglobin,blood urea nitrogen,serum creatinine,estimated glomerular filtration rate,triglyceride,total cholesterol,ferroprotein,serum chlorine,serum phosphorus,serum iron and CO2 binding power between the two groups(all P＜0.05).Dialysis prescription based on bioelectrical impedance analysis results was the independent protective factor in the occurrence of all-cause death(OR=5.188,95％CI:1.148-23.457,P=0.032),cardiovascular death(OR=15.618,95％CI:1.858-131.299,P=0.011)and cardiovascular events(OR=19.772,95％CI:3.096-126.284,P=0.002)in MHD patients.Age was an independent protec-tive factor for the occurrence of cardiovascular death(OR=1.072,95％CI:1.001-1.148,P=0.047)and cardiovascular events(OR=1.111,95％CI:1.022-1.207,P=0.013).Volume abnormalities were inde-pendent risk factors for all-cause death(OR=7.979,95％CI:1.162-54.784,P=0.035)and cardiovas-cular events(OR=73.059,95％CI:1.955-2 730.652,P=0.020).Conclusion Dialysis prescription based on body composition analysis significantly improves cardiovascular prognosis in MHD patients,with in-dependent protection against cardiovascular events,cardiovascular death,and all-cause death.Overhydra-tion is a predictor of the risk of all-cause death and cardiovascular events in MHD patients.
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